Cariprazine

Abstract

Objective Cariprazine is a new antipsychotic drug approved for the treatment of schizophrenia in Europe in 2017. Clinical studies suggest advantages of cariprazine in comparison to other antipsychotic agents regarding therapeutic effects on “negative symptoms”, antipsychotic-induced weight gain and increased serum prolactin levels. Akathisia was reported to be one of the most common side effects. Currently, however, data from naturalistic treatment settings regarding the efficacy, safety and tolerability of cariprazine are missing. Thus, we report and discuss our clinical experiences with cariprazine regarding efficacy, safety and tolerability in order to provide first treatment data from a naturalistic treatment setting. Material and methods The course of treatment of a series of 3 patients with schizophrenia spectrum disorders and treatment with cariprazine (mono- or combined therapy) is presented and discussed. Results Cariprazine demonstrated sufficient antipsychotic effects in 2 out of 3 cases; however, in 2 out of 3 cases treatment had to be discontinued due to akathisia/agitation; in 1 case, cariprazine monotherapy facilitated successful normalization of elevated prolactin serum levels (due to combined treatment with risperidone and olanzapine). Conclusion(s): In general, experience with cariprazine within a naturalistic treatment setting is in accordance with data from clinical studies, particularly concerning effects on “negative symptoms”, antipsychotic-associated elevation of prolactin serum levels and risk of akathisia. The comparatively high incidence of discontinuation of cariprazine due to akathisia/agitation in our case series may be an effect of polypharmacy which was very common among our three cases. Clinical relevance This case series provides some evidence that safety, tolerability and antipsychotic efficacy of cariprazine in naturalistic treatment settings may be similar to findings from the available clinical studies.

Dosing Cariprazine Within and Beyond Clinical Trials: Recommendations for the Treatment of Schizophrenia

“…In case of cariprazine, switching from another antipsychotic can be beneficial if there has been no or only partial response to positive or negative symptoms (27,31,32,35,37,41,43), if the patient suffers from side effects (27,(34)(35)(36)42) that are less common with cariprazine such as weight gain, hyperprolactinemia, sexual disturbance or sedation (44) or if the patients has been prone to non-adherence or substance abuse (29,35).…”

“…When analyzing data from clinical cases however, the picture regarding switching strategies is much more mixed. In case of switching from risperidone, some chose abrupt switching (42), while others discontinued it over 2, 9 or 10 days period while gradually increasing the dose of cariprazine (34,41,43). Similarly, abrupt stop as well as cross-titration over a 3-day, 2-or 3week period was described when switching from olanzapine to cariprazine (34,38,41).…”

“…Even though cariprazine is approved for mono-therapeutic use, polypharmacy-essentially the use of more medicationsis quite common in real-life settings (51,52). In fact, in 5 out of the 29 cases was cariprazine used as an add-on treatment (32,36,42). To give an example, De Berardis and colleagues utilized cariprazine successfully in combination with clozapine in two patients and reported the effects of cariprazine combination to be remarkable not only regarding symptom control but also concerning the management of side effects caused by clozapine (32).…”